Individual
DR. GRACE MACDOWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
11762 S STATE ST STE 160, DRAPER, UT 84020-7174
(801) 654-3229
(801) 601-1408
Mailing address
1635 OHIO ST, WATERTOWN, NY 13601-3032
(315) 681-4112
(315) 282-2888
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
019217
NY
103G00000X
Clinical Neuropsychologist
Primary
9469748-2501
UT
103TC0700X
Clinical Psychologist
019217
NY
103TC2200X
Clinical Child & Adolescent Psychologist
9469748-2501
UT
103TM1800X
Intellectual & Developmental Disabilities Psychologist
019217
NY
103TM1800X
Intellectual & Developmental Disabilities Psychologist
946748-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J300059371
MEDICARE PTAN
NY
Enumeration date
07/08/2011
Last updated
11/05/2020
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